Nationwide, CMIOs in every type of hospital organization are developing strategies for leading their clinical, IT, and administrative colleagues forward through the complex area of quality data reporting under meaningful use. Those CMIOs in organizations at various stages along the journey agree that it will require a subtle combination of persuasion, sharing evidence and data, and a lot of granular hard work in order to get their clinician colleagues fully on board.
Among the small number of hospital organizations to complete the attestation process on April 18, the first day in which attestation of the fulfillment of the Stage 1 requirements for meaningful use under the Health Information Technology for Economic and Clinical Health (HITECH) Act was possible, was the 11-hospital, 24-facility, 4,100-bed Texas Health Resources (THR) integrated system, based in Arlington, Texas. “We felt we were meaningful users, so why shouldn't we attest?” says Ferdinand Velasco, M.D., THR's CMIO.
Texas Health Resources may be ahead of most of its peer organizations when it comes to meaningful use attestation, but, as its CMIO, Velasco has been facing up to the same challenges as his physician informaticist peers nationwide when it comes to leading some key meaningful use-related processes. Among these are some of the most challenging aspects of MU, particularly those around quality data reporting. So what has it been like for CMIOs as they've been leading their colleagues forward in these areas?
“Pulling together the various groups” in order to move forward in this work “is one thing,” says Velasco. “But there's a learning curve involved for everyone, even for clinical informaticists, who may not have a background in clinical quality reporting,” he notes. Among the process challenges: “You have clinicians accustomed to the manual forms of reporting; they expect you can just push a button. But you really have to take it measure by measure, whether it's VTE prophylaxis, discharge instructions for stroke patients, or emergency throughput measures,” he says.
THE WAY I PRESENT IT TO PHYSICIANS IS THAT THE MEANINGFUL USE REQUIREMENTS, IF YOU REALLY LOOK AT THEM, ARE ALL ABOUT IMPROVING PATIENT SAFETY, PATIENT OUTCOMES, AND COMMUNICATIONS WITH YOUR PATIENTS. SO IF WE DO THIS RIGHT, IT WILL BE BETTER FOR THE PATIENTS.-BRIAN PATTY, M.D.
What's more, Velasco emphasizes, “One of the learnings is that there is a gap between the goal-to be able to extract quality indicators from our electronic health record systems-and our ability to do so. Prior to the HITECH Act, in hospitals, we've largely relied on human chart abstraction-human beings painstakingly looking through records; while on the ambulatory side, we've primarily relied on claims data.” Of course, he adds, “In the first year, all that CMS [the federal Centers for Medicare and Medicaid Services] requires is the capability to do reporting. There is not the requirement yet that what we've been doing manually be faithfully reproduced yet electronically.” The next challenge for his organization: testing the ability to begin automated quality outcomes data reporting.
MOVING AHEAD IN MINNESOTA
Another organization that is moving ahead is the three-acute-care hospital, 19-clinic integrated system in the Twin Cities metro area in Minnesota, the HealthEast Care System, based in St. Paul. HealthEast would be capable of attesting to Stage 1 MU later this year, reports vice president and CMIO Brian Patty, M.D., but, he says, “We opted out of 2011, just because the turnaround on submission for Stage 2 was going to be too tight. You would only have four months to get the code from your vendor, get it installed, and get going on Stage 2, because of the fact that the final rule for Stage 2 will be published in July of next year, and you'd then only have three months to attest in October,” Patty notes.
That having been said, Patty says, “We're doing a lot of internal reports right now on each of the measures” required to attest on. What he and his colleagues are learning, Patty says, is how challenging it can be to ensure the full reporting of various measures, when such requirements run smack into the realities of day-to-day clinician workflow. One example of this has to do with the requirement that “More than 50 percent of all unique patients age 2 and over should have height, weight, and blood pressure recorded as structured data.”
That requirement may sound straightforward to non-clinicians, but here's the tricky part: “Nurses initially said to us, ‘Sure, we're certain we're recording 80 percent of vitals on a regular basis,’ but when we actually ran the report on that measure, we found that we were only at 40 percent, because height wasn't being regularly recorded,” Patty says. “Height wasn't thought to be useful data,” he reports, “because it wasn't used regularly.” In other words, meeting that particular MU requirement will mean requiring nurses to regularly record patients' height measures, even though that one data point is not normally useful to them, and will thus demand the insertion of possibly irksome extra tasks into nurses' day-to-day workflows.